Child and adolescent psychiatric disorders predicting adult personality disorder: A follow-up study MIA RAMKLINT, ANNE-LIIS VON KNORRING, LARS VON KNORRING*, LISA EKSELIUS Ramklint M, von Knorring A-L, von Knorring L, Ekselius L. Child and adolescent psychi- atric disorders predicting adult personality disorder: A follow-up study. Nord J Psychiatry 2003;57:23 – 28. Oslo. ISSN 0803-9488. The objective of this study was to examine associations between childhood and adolescent psychiatric disorders and adult personality disorders in a group of former child psychiatric inpatients. One hundred and fifty-eight former inpatients with a mean age of 30.5 7.1 years at investigation had their childhood and adolescent Axis I disorders, obtained from their medical records, coded into DSM-IV diagnoses. Personality disorders in adulthood were assessed by means of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). The predictive effects of child and adolescent Axis I disorders on adult personality disorders were examined with logistic regression analyses. The odds of adult schizoid, avoidant, dependent, borderline and schizotypal personality disorders increased by almost 10, five, four, three and three times, respectively, given a prior major depressive disorder. Those effects were indepen- dent of age, sex and other Axis I disorders. In addition, the odds of adult narcissistic and antisocial personality disorders increased by more than six and five times, respectively, given a prior disruptive disorder, and the odds of adult borderline, schizotypal, avoidant and paranoid personality disorders increased between two and three times given a prior sub- stance-related disorder. The results illustrate an association between mental disorders in childhood and adolescence and adult personality disorders. Identification and successful treatment of childhood psychiatric disorders may help to reduce the risk for subsequent development of an adult personality disorder. • Child and adolescent psychopathology, DIP -Q, Follow -up studies, Mental disorders, Personal - ity disorders. Mia Ramklint, M.D., Ph.D., Department of Neuroscience, Psychiatry, University Hospital, SE-751 85 Uppsala, Sweden. E-mail: mia.ramklint@bupinst.uu.se; Accepted: 9 December 2001. I ndividuals afflicted with childhood and adolescent mental disorders have an increased risk for poor outcome in adulthood (1 – 4). Thus, mental disorders are much more common in adults who have been treated for such disorders in childhood or adolescence (5, 6). In a 22–25-year follow-up study of former child psychiatric inpatients, Thomsen (1) found that approxi- mately one-third of the sample had at least one read- mission after the age of 18 years. There are also significantly higher rates of delinquency, disability and mortality in former adolescent psychiatric inpatients followed up 15 – 33 years after hospitalization as com- pared to those for the general population (3). Previous investigations suggest that there is a sub- stantial association between childhood and adolescent onset of mental disorders and adult personality disor- ders (7 – 9). Specifically, there is an association between childhood disruptive behaviours and personality disor- ders in all clusters, particularly between conduct disor- der and adult antisocial personality disorder (7, 9 – 13). Such an association has also been shown between child and adolescent mood disorders on the one hand, and the emotional dramatic (cluster B) and anxious fearful (cluster C) personality disorders on the other (7), as well as dependent, antisocial, passive – aggressive and histrionic personality disorders (14). There is also an association between anxiety disorders and the anxious fearful (cluster C) and odd eccentric (cluster A) person- ality disorders (7, 8). Finally, there is a very strong link between substance-related disorders and personality disorders, particularly in cluster B (15). Although these studies have linked child and adoles- cent psychopathology to the development of adult per- * Declaration of interest: The author is Editor-in-Chief of the Nordic Journal of Psychiatry. © 2003 Taylor & Francis 23 Nord J Psychiatry Downloaded from informahealthcare.com by Uppsala Universitetsbibliotek on 08/14/13 For personal use only.